1232 MMWR November 13, 2009
5. US Department of Health and Human Services. Objective 27-1a: reduce Health-care providers should continue to encourage persons
tobacco use in adults (cigarette smoking). In: Healthy People 2010 to make their homes completely smoke-free.
(conference ed, in 2 vols). Washington, DC: US Department of Health
and Human Services; 2000. Available at http://www.healthypeople.gov/ BRFSS* conducts state-based, random-digit–dialed tele-
document/html/objectives/27-01.htm. Accessed November 5, 2009. phone surveys of the noninstitutionalized U.S. population
6. CDC. Cigarette smoking among adults—United States, 2006. MMWR aged ≥18 years to collect data on health conditions and health
7. Morrow M, Ngoc DH, Hoang TT, Trinh TH. Smoking and young risk behaviors. The 2008 BRFSS included data from 414,509
women in Vietnam: the influence of normative gender roles. Soc Sci respondents, which were used to assess current smoking
Med 2002;55:681–90. prevalence.† The questions to assess SHS exposure and home
8. Caraballo RS, Giovino GA, Pechacek TF, Mowery PD. Factors associ-
ated with discrepancies between self-reports on cigarette smoking and
smoking rules§ were offered to states as an optional module and
measured serum cotinine levels among person aged 17 years or older: were used by 11 states and USVI, which combined represented
third National Health and Nutrition Examination Survey, 1988–1994. approximately 19% of the U.S. adult population in 2008.
Am J Epidemiol 2001;153:807–14. BRFSS estimates were weighted to the respondent’s prob-
9. CDC. State-Specific secondhand smoke exposure and current
cigarette smoking among adults—United States, 2008. MMWR ability of being selected and the age-, sex-, and race/ethnicity-
2009;58:1232–5. specific populations from 2008 estimates projected from the
10. John R, Cheney MK, Azad MR. Point-of-sale marketing of tobacco 2000 Census for each state, DC, and the U.S. territories.
products: taking advantage of the socially disadvantaged? J Health Care
Poor Underserved 2009;20:489–506. These sampling weights were used to calculate all estimates
and 95% confidence intervals. Response rates for BRFSS are
calculated using Council of American Survey and Research
Organizations (CASRO) guidelines.¶ Median survey response
rates were 53.3% and median cooperation rates were 75.0%.
State-Specific Secondhand Smoke
For comparisons of prevalence between males and females and
Exposure and Current Cigarette smokers and nonsmokers statistical significance (p<0.05) was
Smoking Among Adults — determined using a two-sided z-test.
United States, 2008
Secondhand Smoke Exposure
Secondhand smoke (SHS) causes immediate and long-term and Smoke-Free Home Rules
adverse health effects in nonsmoking adults and children,
In the 11 states and USVI, the percentage of persons who
including heart disease and lung cancer, and SHS exposure
reported being exposed to SHS inside their home ranged from
occurs primarily in homes and workplaces (1). Smoke-free
3.2% (Arizona) to 10.6% (West Virginia) (median: 7.8%),
policies, including not allowing smoking anywhere inside the
and SHS exposure in indoor workplaces ranged from 6.0%
home (i.e., having a smoke-free home rule), are the best way
(Tennessee) to 17.3% (USVI) (median: 8.6%) (Table 1).
to provide protection from exposure to SHS. To assess SHS
exposure in homes and indoor workplaces and the prevalence * BRFSS survey data information available at http://www.cdc.gov/brfss/
of smoke-free home rules, CDC analyzed 2008 Behavioral technical_infodata/surveydata/2008.htm.
† Those respondents who answered “yes” to the question “Have you smoked
Risk Factor Surveillance System (BRFSS) data from 11 states
at least 100 cigarettes in your entire life?” and answered “every day” or “some
and the U.S. Virgin Islands (USVI). This report summarizes days” to the question “Do you now smoke cigarettes every day, some days, or
the results, which showed wide variation among states in expo- not at all?” were classified as current cigarette smokers. Persons who reported
either never having smoked 100 cigarettes (never smokers) in their life or those
sure to SHS in homes (from 3.2% [Arizona] to 10.6% [West who had smoked but were not current smokers (former smokers) together were
Virginia]) and indoor workplaces (from 6.0% [Tennessee] classified as nonsmokers.
§ Exposure to SHS at home was determined by asking, “On how many of the
to 17.3% [USVI]). The majority of persons surveyed in the
past 7 days, did anyone smoke in your home while you were there?” Exposure
11 states and USVI reported having smoke-free home rules to SHS in indoor workplaces was determ